Report on anaemia, or beri-beri, of Ceylon / by W.R. Kynsey.

  • Ceylon. Civil Medical Officer.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Report on anaemia, or beri-beri, of Ceylon / by W.R. Kynsey. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    both, predisposition increases with the length of time spent at the focus of the disease, and a residence of some months is necessary before the disease is developed ; and as regards race, the natives suffer more than Europeans, but the latter living under the same conditions as the natives suffer equally. In both, the anchylostoma duodenale is found : in mild cases in small numbers, in severe cases in large numbers ; and in old atrophic cases there is evidence they were present, although none are found on post-mortem examination : neither are communicable from person to person. In both, anthelmintic remedies give relief or cure, and in both sudden death, so promi- nently alluded to in old descriptions of beri-beri, and by Professor Maclean, is appallingly frequent. 19. The comparatively more frequent occurrence of beri-beri among men as compared with women and children, is because adult males come more in contact with the sources of infection by working away from home on brickfields, mines, roads, and paddy or rice fields, where they drink impure water. Women and children, if equally exposed, would contract the disease. If the men of a family are alone infected, it points to the source of infection being outside the dwelling; if all the members of a family suffer, the source of infection is close by. The difference in the effects of the parasites on women and children depends on the number present in the intestines, the amount of work, and the nature of the food. Race offers no immunity : Europeans suffer equally with natives,— this was so in the army in Ceylon in the old pre-sanitary period. The occurrence of the disease on board ship is due to the fact that the men come on board with the parasites, or contract these on board from impure drinking-water. In the first case, the disease used to break out when the men began to feel the effects of deficient or bad rations. The women and children suffered less, or not at all, because they had fewer or no parasites. The difference in the effects of the parasites in the tropics and in Europe ia one of degree, and depends on their number and the nature of the food. The rapid recovery in recent cases on leaving the focus of the disease is due to removal from the sources of infection combined very frequently with better living. The embryos of the anchylostoma develop more rapidly in rainy weather, when the temperature is between 25° and 30'^ 0., and the atmosphere moist: a lower temperature delays or stops the development altogether. They develop well in moist earth : consequently, in seasons and places where these conditions exist, persons are most frequently attacked ; a cold dry season often brings an outbreak to an end. The disease is frequent along the banks of rivers, particularly those liable to overflow their banks, as the ova are carried away from their source and deposited in shallow places, where they undergo development and gain entrance into the human system in the water used for drinking. 20. In this report it is only necessary to give a brief description of the parasite and the disease produced by it, and a summary of Lutz's observations: for fuller details I must refer to his admirable and exhaustive treatise, which leaves nothing to be desired. The Anchylostoma duodenale, or Anchylostomum duodenale, or Sclerostoma duodenale, or Dochmius duodenalis—Lutz adopting the first form—was discovered in Milan by Dubini, in 1838. It belongs to the genus Dochmius, order Nematodes, family Strongylidee, and, along with the order Acanthocephala, forms the class Nemathelminthes. The disease produced by its presence is called anchylostomiasis, or anchylostomoses. 21. It is scarcely possible to mistake the anchylostoma for any other human parasite. The form of the body is fairly compact, cylindrical ; the length exceeds the breadth twenty times ; whitish ash-coloured, reddish, or black. The head is plainly seen bent towards the dorsal side. The posterior extremity is not bent—is pointed in the female and broad in the male ; length varies from 6 to 15 mm. The smallest female observed was 7 mm. in length, the largest among several hundred 15 mm. Leuckart found the length of the female 10 to 12 mm., rarely 18 mm.; the greatest thickness 1 mm. He found the male 6 to 8 mm. in length, rarely 10 mm. They are found in the upper part of the small intestines in the duodenum, and particularly in the upper part of the jejunum, where they avoid, according to Bilharz, the direct effect of the bile. 22. By suction the blood is taken into the intestines, and, according to Grassi, it is probable it is again evacuated, more or less unchanged, when a new supply is taken in. The worm apparently lives on the blood plasma without interference with the blood corpuscles, so that an absorption, not a digestive process, occurs. It becomes as it were an addition to the vascular system of its host, whose blood circulates in it. Lutz makes the following calculation of the loss of blood from the suction of these parasites :— Supposing even the daily requirements of each only amounted on an average to one drop, which probably is too small an average, the daily loss caused by five hundred worms would amount to 20 grammes (5 drachms), which, con- sidering the rich supply of nourishment this blood contains, is sufficient in time to cause a pronounced form of anaemia. Five hundred anchylostoma, the intestines of which are empty, weigh 2 grammes, and double this probably when full of blood. Now, supposing this blood is renewed every two hours,—a supposition which has nothing impossible about it,—the loss is seen to be considerable. The parasite bites its way into the mucous membrane, pierces the submucous cellular tissue, and subsists on the blood. After its removal there remains an ecchymosis, the size of a lentil, the centre of which presents a white spot of the size of a pin's head with a fine hole; out of these wounds blood oozes into the intestinal cavity. (Wagner.) 23. The larvas of the anchylostoma are found wherever there are accumulations of faeces, on moist, uneven ground containing water, in localities occupied by men and animals where there are no latrines, or badly constructed ones. Such conditions exist in the villages of Ceylon, and on many of the coffee estates, and in such, a number of the inhabitants are found to suffer from anchylostomiasis. The number of larvse is found to be enormous, and, according to Lutz, may be counted by millions. The larvae find entrance into the body in the drinking-water, or from the soil itself, or from soiled vessels or clothing. Labourers who take their meals on the spot, and carry their food to their mouths with soiled fingers ; children, after crawling on the dirty ground on their hands carry them to their mouths and become infected. [ 542 ]